As COVID-19 relief comes to an end on May 11, 2023, long-term healthcare providers must be prepared to shift back to a pre-pandemic world – at least in regards to certain provisions and flexibilities that will soon cease to exist. Providers need to regroup, adjust office protocols and change certain behaviors to meet the stricter (original) requirements forthcoming, if they want to avoid penalties and unnecessary financial risk.  

While providers are preparing for these upcoming adjustments, they should take this as an opportunity to review and improve the bigger financial picture, starting with the revenue cycle. A lot of good insight can be gained by analyzing key performance indicators such as days sales outstanding, debt ratio and collection rate, but the numbers alone cannot convey the source of an organization’s inefficiencies.

In our experience as the industry’s leading LTPAC performance advisor, some of the most common mistakes can prove to be the costliest. By making a conscious effort to STOP doing these five things, your organization can increase collection rates, improve customer service and ultimately enhance the patient experience.

1. STOP shortcutting admissions 

The admissions process must be performed faithfully for every patient because it is a critical element that will impact a provider’s ability to collect future payments. Adherence to the process means admissions staff must obtain and verify insurance information before service begins. Assumptions should never be made regarding a patient’s coverage, including whether they are traditional Medicare or Managed Care Medicare. There are differences in these plan requirements, and if you assume one plan but it ends up being the other, you may miss your opportunity to be fully reimbursed. With that in mind, it is a good practice for skilled nursing facilities (SNFs) to perform a five-day assessment for every resident, to keep your bases covered. If an assessment is not completed within this window and it is later determined that it was a requirement of the resident’s insurance plan, the SNF has missed their chance and now risks being reimbursed at the lowest possible rate.

Just because a patient held a certain coverage at the time they were admitted does not mean that exact coverage will remain forever. Patients can elect to change their plans even outside of open enrollment, and they may not always remember to update their providers. Providers have tools at their disposal to verify eligibility, and this task should not be taken lightly. Eligibility must be verified for each patient at least once a month (or more often, depending on payer) before a bill is issued. While this might seem like a daunting task, many AR systems have built-in applications that make it as easy as a click of a button. Another option for providers is to go directly into a payer’s system or their clearinghouse and manually look it up. In either case, it is important to read the eligibility response. Don’t just click the button and see that it is approved; open the document and read the information – specifically noting whether the resident is eligible for Medicare or Managed Care Medicare specific services. Failure to conduct this due diligence each month could result in missed authorizations, delays from billing the wrong payer, claim denials, and loss of reimbursement revenue.

3. STOP procrastinating billing

You cannot expect to be paid for services if you have not billed for services. Seems simple enough, right? The sooner providers can bill, the quicker they will receive payments. Payments received timely equate to a healthy cash flow. 

Providers must get to know payer rules so they can bill at the most opportune time. Residents with private pay insurance should be pre-billed before services are provided. Think of it this way; have you ever lived in an apartment where you paid rent at the end of the month? Probably not. It is typically due on the 1st of the month, and although in some cases there may be a small grace period, if payment is not received by the 5th of the month, you are likely going to be penalized with a late fee or another ramification. Residents of nursing homes or assisted living facilities should operate similarly. Keep in mind that many residents may be on a fixed income, so bills need to be sent timely before social security checks are received, when the funds are more likely to be available.

4. STOP throwing away co-insurance dollars

Don’t get into the bad habit of putting co-insurance on the back burner. After a claim is paid by the primary insurer, make sure you circle back and bill any remaining amount to the secondary responsible party, whether this is the resident themselves or a secondary insurance. Even if these are smaller dollar amounts individually, these can add up to a significant cumulative loss over time. Again, make sure you identify the right payer and adhere to filing timelines because any issues in submitting claims to the primary payer will trickle down to the secondary payer and then the resident, who is the last in line to receive their bill. When the entire process is heavily delayed, bills go unpaid and revenue is never recovered.

5. STOP dismissing your denials

Denials management is a vital but sometimes underestimated element of the healthcare revenue cycle. The industry has faced an increase in denied claims over the last several years, and the majority of those denied claims are unfortunately never resubmitted. Providers are leaving a significant amount of money behind when denials are not treated as a priority. Strict payer rules dictate how long providers have to correct, resubmit, and appeal claims (if necessary). Once deadlines have passed, providers have missed any chance of receiving reimbursement and the claims must be written off as a loss.  Understanding your payer rules and claim submission timelines is the first step to preventing loss.  Establishing a Triple Check Process to ensure billing accuracy before submission will also help reduce avoidable errors. 
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Enhance Outcomes with Richter

Bad habits are hard to break, but with the right partner, providers can identify areas of risk and develop corrective strategies that will improve revenue cycle performance and facility outcomes. Richter’s Revenue Cycle and Reimbursement Consulting team will help your organization increase cash flow, reduce denials, and avoid compliance jeopardy. To learn more about our comprehensive solutions, contact us here or call us at 866.806.0799.